Abstract
Background
This study aimed to compare the oncologic results for local excision via transanal endoscopic microsurgery (TEM) and those for laparoscopic resection (LR) via total mesorectal excision in the treatment of T2 N0, G1-2 rectal cancer after neoadjuvant therapy with both treatments, incorporating a 5-year minimum follow-up period.
Methods
The study enrolled 70 patients whose malignancy was staged at admission as T2 N0, G1-2 rectal cancer located within 6 cm of the anal verge with a tumor diameter less than 3 cm. Of these patients, 35 were randomized to TEM and 35 to LR. The patients in both groups previously had undergone high-dose radiotherapy (5,040 cGy in 28 fractions over 5 weeks) combined with continuous infusion of 5-flurouracil (200 mg/m2/day).
Results
The median follow-up period was 84 months (range, 72–96 months). Two local recurrences (5.7%) were observed after TEM and 1 (2.8%) after LR. Distant metastases (2.8%) occurred in one case each after TEM and LR. The probability of survival for rectal cancer was 94% for TEM and 94% for LR.
Conclusions
The study shows similar results between the two treatments in terms of local recurrences, distant metastases, and probability of survival for rectal cancer.
Similar content being viewed by others
References
Neary P, Makin GB, White TJ, White E, Hartley J, MacDonald A, Lee PWR, Monson JRT (2003) Transanal endoscopic microsurgery: a viable operative alternative in selected patients with rectal lesions. Ann Surg Oncol 10:1106–1111
Bozzetto F, Baratti D, Andreola S, Zucali R, Schiavo M, Spinelli P, Gronchi A, Bertario L, Mariani L, Gennari L (1999) Preoperative radiation therapy for patients with T2–T3 carcinoma of the middle-to-lower rectum. Cancer 86:398–404
Habr-Gama A, Perez RO, Kiss DR, Rawet V, Scanavini A, Santinho PM, Nadalin W (2004) Preoperative chemoradiation therapy for low rectal cancer: impact on downstaging and sphincter-saving operations. Hepatogastroenterology 51:1703–1707
Nastro P, Beral D, Hartley J, Monson JRT (2005) Local excision of rectal cancer: review of literature. Dig Surg 22:6–15
Schell SR, Zlotecki RA, Mendenhall WM, Marsh RW, Vauyhey JN, Copeland EM III (2002) Transanal excision of locally advanced rectal cancers downstaged using neoadjuvant chemoradiotherapy. J Am Coll Surg 194:584–591
Heintz A, Morschel M, Junginger T (1998) Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum. Surg Endosc 12:1145–1148
Palma P, Freudenberg S, Samel S, Post S (2004) Transanal endoscopic microsurgery: indications and results after 100 cases. Colorectal Dis 6:350–355
Sengupta S, Tjandra JJ (2001) Local excision of rectal cancer: what is the evidence? Dis Colon Rectum 44:1345–1361
Varma MG, Rogers SJ, Schrock TR, Welton ML (1999) Local excision of rectal carcinoma. Arch Surg 134:863–867, discussion 867–868
Winde G, Nottberg H. Keller R, Schmid KW, Bunte H (1996) Surgical cure for early rectal carcinomas (T1): transanal Endoscopic microsurgery vs anterior resection. Dis Colon Rectum 39:969–976
Lezoche E, Guerrieri M, De Sanctis A, Campagnacci R, Baldarelli M, Lezoche G, Paganini AM (2006) Long-term results of laparoscopic vs open colorectal resections for cancer in 235 patients with a minimum follow-up 5 years. Surg Endosc 20:546–553
Marks G, Mohiuddin M, Masoni L (1993) The reality of radical sphincter preservation surgery for rectal of the distal 3 cm of rectum following high-dose radiation. Int J Radiat Oncol Biol Phys 27:779–783
Marks G, Mohuiddin M, Rakinic J (1991) New hope and promise for sphincter preservation in the management of cancer of the recum. Semin Oncol 18:88–98
Marks G, Mohuiddin M, Masoni L, Pecchioli L (1990) High-dose preoperative radiation and full-thickness local excision: a new option for patients with select cancers of the rectum. Dis Colon Rectum 33:735–739
Lezoche E, Guerrieri M, Paganini AM, Feliciotti F (2002) Long-term results of patients with pT2 rectal cancer treated with radiotherapy and transanal endoscopic microsurgical excision. World J Surg J 26:1170–1174
Lezoche E, Guerrieri M, Paganini AM, D’Ambrosio G, Baldarelli M, Lezoche G, Feliciotti F, De Sanctis A (2005) Transanal endoscopic microsurgery versus total mesorectal laparoscopic resections of T2-N0 low rectal cancer after neoadjuvant treatment: a prospective randomized trial with a 3 years minimum follow-up period. Surg Endosc 19:751–756
Buess G, Mentges B (1992) Transanal endoscopic microsurgery (TEM). Minim Invasive Ther 1:101–109
Kim CJ, Yeatman TJ, Coppola D, Trotti A, Williams B, Barthel JS, Dinwoodie W, Karl RC, Marcet J (2001) Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. Ann Surg 234:352–358, discussion 358–359
Rodel C, Martus P, Papadoupolos T, Fuzesi L, Klimpfinger M, Fietkau R, Hohenberger W, Raab R, Sauer R, Wittekind C (2005) Prognostic significance of tumor regression after chemoradiotherapy for rectal cancer. J Clin Oncol 23:8688–8696
Vecchio FM, Valentini V, Minsky BD, Padula GD, Venkatraman ES, Balducci M, Micciche F, Ricci R, Morgani AG, Gambacorta MA, Maurizi F. Coco C (2005) The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncl Biol Phys 62:752–760
Martling AL, Holm T, Rutqvist LE, Moran BJ, Heald RJ, Cedemark B (2000) Effect of surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet 356:93–96
Chakravarti A, Compton CC, Shellito PC, Wood WC, Landry J, Machuta SR, Kaufman D, Aucukiewicz M, Willett CG (1999) Long term follow up of patients with rectal cancer managed by local excision with and without adjuvant irradiation. Ann Surg 239:49–54
Lee W, Lee D, Choi S, Chun H (2003) Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer. Surg Endosc 17:1283–1287
Ruo L, Guillem JG, Minsky BD, Quan SH, Paty PB, Cohen AM (2002) Preoperative radiation with or without chemotherapy and full-thickness transanal excision for selected T2 and T3 distal rectal cancers. Int J Colorectal Dis 17:54–58
Acknowledgments
The authors are grateful to Professor Flavia Carle from the Department of Epidemiology and Statistics of the University “Politecnica delle Marche,” Ancona for her contribution.
Author information
Authors and Affiliations
Corresponding author
Additional information
An erratum to this article can be found at http://dx.doi.org/10.1007/s00464-007-9714-x
Rights and permissions
About this article
Cite this article
Lezoche, G., Baldarelli, M., Mario et al. A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 22, 352–358 (2008). https://doi.org/10.1007/s00464-007-9596-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9596-y